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General NPI Number Information
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NPI Number | 1467886507
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Entity Type | Organization
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Legal Business Name | KARL VON TIEHL, MD, INC.
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 375 HUNTINGTON DR SUITE C
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City | SAN MARINO
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State | CA
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Zip | 91108-2357
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Country | US
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Telephone | 626-460-6038
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Fax | 877-886-6123
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Provider Business Mailing Address
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Address Line | 375 HUNTINGTON DR SUITE C
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City | SAN MARINO
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State | CA
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Zip | 91108-2357
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Country | US
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Telephone | 626-460-6038
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Fax | 877-886-6123
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. KARL FRIEDRICH VONTIEHL
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Credential | M.D.
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Telephone | 858-699-4949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A95085
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License Number State | CA
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